Tell Your Story

One of the National Breast Cancer Coalition’s (NBCC) legislative priorities is adding metastatic breast cancer as a qualifying condition for Medicare coverage. Wisconsin Breast Cancer Coalition (WBCC) supports this legislative priority. As envisioned, this legislation would waive all waiting periods for Medicare eligibility on the basis of disability for individuals with metastatic breast cancer and provide Medicare health care coverage for the treatment and alleviation of symptoms relating to metastatic breast cancer.

If you or a loved one have been diagnosed with metastatic breast cancer, we would appreciate hearing your story about how waiving Medicare waiting periods would affect you and your family. Stories from women and men like you can advance this important legislative priority. We – NBCC and WBCC – will use the collected stories to help support NBCC’s national initiative.

NBCC and WBCC believe that quality care must be accessible to everyone. Making certain all those with metastatic disease have access is an important and major step.

Your story is important, and it needs to be heard.

Here is what we would like to know:

* Denotes required fields.

Name:*
Address:*
City:*
State:*
ZIP code:*

Phone:*
Email:*

Date of breast cancer diagnosis:
Age at time of diagnosis:
Date of metastatic disease diagnosis:
Age at time of diagnosis:

Financial impact of breast cancer (check all that apply):
No insurance coverage at time of diagnosisInadequate insurance coverage at time of diagnosisUsed retirement account to pay out-of-pocket expensesPaid out-of-pocket expenses with credit cardNeeded family assistance to pay for treatmentAltered or skipped medication to save moneySkipped chemotherapy treatments to save moneyWas unable to work for extended period (more than 4 weeks) because of illnessWent into debtLost my jobDeclared bankruptcyLost my home

Married:	YesNo
Children?	YesNo
How many?

Tell Us Your Story:*

In submitting this story to the WBCC, you are agreeing to let WBCC and NBCC use your name, the details of your story, and the personal information you include in their efforts to add metastatic breast cancer as a qualifying condition for Medicare and Social Security Disability coverage.
Yes, I agreeNo, I do not agree

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